1. Healthcare

Application for Admission
2015-2016 School Year
Mail or deliver applications to:
Admissions Office
Cristo Rey Columbus High School
400 East Tow n Street
Columbus, Ohio 43215
Phone: (614) 223-9261 x 12008
[email protected]
Cristo Rey Columbus High School
Admission for 2015-2016 School Year
Deadlines for Applications
Early Admission Deadline………………..………Friday, November 14, 2014
Regular Admission…………..….………….……. Friday, February 6, 2015
Part 1- Application
In order for your application to be processed, your file must include the following items.
Application for Admission (this packet)
Student must be eligible to work in the United States
Submit Request for Records form (yellow packet) to student’s current school
requesting:
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Completed Recommendation Form from English teacher
Completed Recommendation Form from Math teacher
Completed School Leader or Community Leader Recommendation Form
Copy of Report Cards, discipline records, and attendance records from current and
previous grade
Copy of Standardized Test scores from current and previous grade
IEP/ISP records, if applicable
Financial Aid Forms
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FACTS Tuition Aid Application (must include $30 processing fee)
Part 2- Interview
Applicants who complete their applications may move into the second phase of the admissions
process. Applicants who meet the criteria to be a Cristo Rey Columbus student may be invited to
interview with the Director of Admissions or other school representative.
Student and Parent/Guardian interview with the Director of Admissions or other
school
representative
Part 3- Entrance Exam
Applicants will also take the Cristo Rey Columbus High School Entrance Exam on one of the
dates below. Please call 223-9261 to reserve a space.
Entrance Exam………………..………Saturday, October 25, 2014; 10 am -12:30 pm
Entrance Exam………………..………Saturday, November 22, 2014; 10 am -12:30 pm
Entrance Exam………………..………Saturday, December 20, 2014; 10 am -12:30 pm
* More dates may be added if needed.
For Accepted Students only
Part 4- Registration
Students will receive notification of admission to Cristo Rey Columbus High School via mail.
Students who are accepted and plan to attend Cristo Rey Columbus must register to secure their
placement in the class.
Register at Cristo Rey Columbus and submit $50 Registration Fee
APPLICATION INSTRUCTIONS
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OFFICE USE ONLY
Please type or print clearly.
Use blue or black ink.
Fill in all blanks provided.
Date Received _________
Staff Receiving _________
SECTION A: STUDENT’S PERSONAL DATA
Full Name (as on Birth Certificate):
Last
First
Current School:
Birth Date:
Middle Initial
Grade: __________
/
Religion (optional):
/
Month
Day
Year
Please mark racial and/or ethnic identity (optional)
Black or African American
Caribbean Islander
Hispanic or Latino
Asian
White
Other __________________
Home Address:
Address
Home Phone:
Gender
:
Apt.
City
-
Male
State
Zip
Birth Place:
Female
Language spoken at home:
Other Languages Spoken:
Student’s Cell Phone (optional):
-
-
Student Lives With: (Check all that apply.)
Mother only
Father only
Both Parents
Grandmother
Grandfather
Aunt or
Uncle
Foster Care Provider
Other–Relationship: _____________________________________
Parent/Guardian’s Current Marital Status: (Check all that apply.)
Single Parent
Parents Married
Parents Together
Divorced
Separated
Remarried
Father Remarried
Mother Deceased
Father Deceased
Under DYFS Custody
Mother
SECTION B: STUDENT QUESTIONNAIRE
This must be completed in student’s own handwriting, without parental assistance. If needed, use
additional paper or the back of this page.
Student Name: _______________________________
Date: _______________________
Give an example of a time when you struggled with something (academic or non-academic related)
and how you handled the situation:
Do you know any current Cristo Rey students? If so, who?
___________________________________________
__________________________________________________________________________________________
How did you hear about Cristo Rey Columbus? (check all that apply)
☐ Cristo Rey Representatives visited my school ☐ Cristo Rey Representatives visited my church
☐ Friend, neighbor, or relative
☐ Teacher, counselor, or clergy
☐ Community event (festival,
fair, etc.)
☐ Received something in the mail
☐ Received a phone call
☐ Newspaper Article
Radio Ad
What high school would you attend next year if you do not attend Cristo Rey Columbus?
What is your district home high school?
Please list three words you would use to describe yourself:
☐
SECTION C: FAMILY INFORMATION (to be completed by parent or guardian)
Personal Data of Parent or Guardian 1
Full Name:
Last
Gender:
Male
First
Female
Middle Initial
English Speaker:
Yes
No
If no, list preferred spoken language: __________________
Relationship to Student:
Legal Guardian?
Yes
No
Home Address:
Address
Apt.
Home Phone:
City
-
-
Work Phone:
-
State
Zip
-
Employer:
Occupation:
Parent Cell Phone:
-
-
Please check the best way to contact you.
______ Work Phone
______ Home Phone
______ Cell Phone
______ Text
Message
______ Email
If email is a preference, please write your email address: ________________________________
Personal Data of Parent or Guardian 2
Full Name:
Last
Gender:
Male
First
Female
Middle Initial
English Speaker:
Yes
No
If no, list preferred spoken language: __________________
Relationship to Student:
Legal Guardian?
Yes
No
Home Address:
Home Phone:
Apt./Street
-
Work Phone:
-
-
Employer:
Parent Cell Phone:
City
Occupation:
-
-
State
Zip
Please check the best way to contact you.
______ Work Phone
Message
______ Email
______ Home Phone
______ Cell Phone
______ Text
If email is a preference, please write your email address: ________________________________
SECTION D: PARENT QUESTIONNAIRE (to be completed by parent or guardian)
List all schools the student has attended in the last THREE years:
(1)
Current School
City, State
Year(s) Attended
School
City, State
Years(s) Attended
School
City, State
Years(s) Attended
School
City, State
Year(s) Attended
(2)
(3)
(4)
Learning and Medical Profile
Has the student been diagnosed with a learning disability?
Yes
No
Has the student been diagnosed with ADD or ADHD?
Yes
No
Has the student now or ever been enrolled in special education classes?
Yes
No
Has the student been enrolled in English as a Second Language (ESL) classes?
Yes
No
Does the student currently have, or ever had, an Individual Education Plan (IEP)?
If Yes, a copy of the IEP must be included with the application.
If you answered YES to any of the questions above, please explain below.
Why do you want your son or daughter to attend Cristo Rey Columbus?
Why do you believe he or she would do well here?
Yes
No
Household Income
How many adults live in your house? ______
Relationship(s) to child:
_________________________________
How many children live in your house? ______
Relationship(s) to child:
________________________________
Please check the most appropriate range of your total household income.
Less than $20,000
$20,001-40,000
$60,001-80,000
______$40,001-60,000
_____ Higher than $80,000
* All applicant families are required to complete the FACTS Financial Application before receiving an official admissions decision from
Cristo Rey Columbus.
IMPORTANT NOTE TO STUDENTS, PARENTS AND GUARDIANS:
Please review carefully and sign below.
I understand that Cristo Rey Columbus High School is an academically challenging, Catholic school
with a code of mandatory attendance, dress, and conduct. The hallmark of the school is its Professional
Work-Study Program in which the students work one full day each week and a fifth day approximately
every four weeks of the school year, excluding holidays and days when school is closed. I understand
the student’s earnings will be used to fund a portion of the cost of their high school education. I further
understand that full participation of parents and guardians is necessary in order to fulfill requirements
of the school.
Admission to Cristo Rey Columbus High School is subject to our receipt of an official transcript
demonstrating successful completion of the applicant’s current grade and satisfactory completion of our
mandatory summer business training program. Admission and enrollment decisions are made at the
sole discretion of Cristo Rey Columbus administration. I certify that the information furnished in this
application is complete and accurate. Furthermore, I understand that if I knowingly provide false
information, my child’s admissions may be jeopardized.
My signature indicates my permission for the release of my child’s school records to Cristo Rey
Columbus High School.
Student Signature
Date
Parent/Guardian Signature
Date
NOTA IMPORTANTE PARA ESTUDIANTES, LOS PADRES O REPRESENTANTES:
Por favor revise cuidadosamente y firme a continuación.
Comprendo que la Escuela Secundaria Cristo Rey de Columbus es una escuela católica con un riguroso
programa académico que posee un código de asistencia obligatoria, vestimenta y conducta. La marca
que diferencia esta escuela es su Programa Profesional de Trabajo-Estudio en el cual los estudiantes
trabajan un día entero cada semana y un quinto día durante cada cuatro semanas del año escolar
aproximadamente, con excepción de los días feriados y los días en que no haya clase. Comprendo que
lo que gane el estudiante cubrirá una porción del costo de su educación secundaria. Afirmo que
comprendo que la participación total de los padres y representantes es necesaria para cumplir los
requisitos de la escuela.
La admisión a la Escuela Secundaria Cristo Rey de Columbus está sujeta al recibo de un certificado
académico oficial que demuestre que el aspirante completó satisfactoriamente el grado actual y nuestro
campamento de entrenamiento profesional de verano obligatorio. Las decisiones de admisión e
inscripción se realizan exclusivamente a discreción de la administración de Cristo Rey de Columbus.
Certifico que la información proporcionada en esta aplicación es completa y precisa. Y, además, afirmo
que si proveo información falsa, la admisión de mi hijo(a) será perjudicada.
Mi firma indica mi autorización para emitir los archivos de mi hijo(a) a la Escuela Secundaria Cristo Rey
Columbus..
Firma del Estudiante
Fecha
Firma del Padre
Fecha